Health & Wellness

Pharmacy

Flexible Benefits Designs

EmblemHealth Gives Your Institution Choice and Flexibility

Our broad selection of plans gives you the flexibility to offer multiple options to your faculty and staff.

Our PPO and InBalance PPO (Preferred Provider Organization) plans feature the EmblemHealth National Network and combine family-friendly benefit designs with freedom of provider choice. No referrals are required. They also offer members out-of-network coverage for additional out-of-pocket costs. The InBalance option lowers group premiums by applying member cost-sharing for certain services received in-network.

Our EPO andInBalance EPO (Exclusive Provider Organization) plans provide access to the
EmblemHealth National Network and offer family-friendly, in-network-only benefits that make these plans attractive and affordable. No referrals are required. The InBalance option lowers group premiums by increasing member cost-sharing for certain services.

Ou Consumer Direct PPO and Consumer Direct EPO plans provide access to the EmblemHealth National Network and offer low group premiums based on higher-than-customary member deductibles. These high-deductible health plans help groups offset member costs with tax-saving Health Savings Accounts (HSAs).1

Our CompreHealth EPO provides in-network-only benefits with no referrals required, and offers access to the EmblemHealth NY Metro Network, with leading physicians and other medical practitioners across New York City and Nassau, Suffolk and southern Westchester counties. In addition to physicians in private practice, it features multispecialty physician group practices that offer a broad range of medical services, often under one roof, as well as access to the metro area’s leading hospitals.

Our Dental Plans provide a choice of three programs featuring different benefit designs, network size and cost-sharing responsibilities, ranging from paid-in-full network coverage to in-network discounts on more costly services.

Our Pharmacy Benefit Services, available by separate rider, provides a wide range of retail and mail-order prescription drug benefits, as well as an extensive formulary of drugs covered by the prescription plan.

Your EmblemHealth sales representative will work closely with you to help put together a benefit plan design that best serves the needs of your institution.

1 HSAs are options the group may add to its HDHP plan. Groups must make arrangements for the HSA before offering it to their members.

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